TY - JOUR
T1 - Clinical decision-making and the nursing process in digital health systems
T2 - An integrated systematic review
AU - Hants, Laura
AU - Bail, Kasia
AU - Paterson, Catherine
N1 - Funding Information:
This paper was produced as part of Laura Hants' honours project; therefore, thanks are extended to the research educators within the University of Canberra's Health Science Honours Program. This review protocol was registered with the International prospective register of systematic reviews PROSPERO (CRD42022313009). Open access publishing facilitated by University of Canberra, as part of the Wiley - University of Canberra agreement via the Council of Australian University Librarians.
Publisher Copyright:
© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.
PY - 2023/10
Y1 - 2023/10
N2 - AIMS: To identify how the nursing process (assessment, planning, intervention and outcome evaluation) has been incorporated into digital health systems (electronic medical records, electronic care plans and clinical decision support systems) to gain an understanding of known benefits and challenges posed to nurses' decision-making processes.BACKGROUND: Nursing terminologies, including the International Classification for Nursing Practice (ICNP), and Nursing Minimum Data Set's (NMDS), have been developed to improve standardised language integration of components of nursing care into digital systems. However, there is limited evidence regarding whether the complete nursing process is effectively being incorporated into digital health systems.METHODS: An integrative systematic review following PRISMA guidelines. A search strategy was applied to extract articles from included databases: CINAHL, MEDLINE, SCOPUS and Web of Science Core Collection. Articles were limited to English language and published January 2007-March 2022 and assessed using a pre-determined eligibility criteria. Quality assessment and a narrative synthesis were conducted.RESULTS: A total of 3321 articles were identified, and 27 studies included. There were (n = 10) qualitative, (n = 4) quantitative non-randomised controlled trials, (n = 3) quantitative descriptive studies and (n = 10) mixed methods. Nurse assessment and planning components were the most comprehensive phases incorporated into digital health systems, and interventions and outcome evaluation were scarcely reported.CONCLUSIONS: Inadequate capture of nursing work is a problem unresolved by digital health systems. This omission may be hindering nurse clinical decision-making for patient care and limiting the visibility of the nursing role in health care interventions and the associated impact on patient outcomes.RELEVANCE TO CLINICAL PRACTICE: Further research is needed on how digital systems can support nurses to apply the full nursing process and to further evaluate patient outcomes. Digital systems can support health-service level evaluation through capturing missed nursing care and the consequences on patients utilising nurse-sensitive-outcomes; however, this is not yet being realised.
AB - AIMS: To identify how the nursing process (assessment, planning, intervention and outcome evaluation) has been incorporated into digital health systems (electronic medical records, electronic care plans and clinical decision support systems) to gain an understanding of known benefits and challenges posed to nurses' decision-making processes.BACKGROUND: Nursing terminologies, including the International Classification for Nursing Practice (ICNP), and Nursing Minimum Data Set's (NMDS), have been developed to improve standardised language integration of components of nursing care into digital systems. However, there is limited evidence regarding whether the complete nursing process is effectively being incorporated into digital health systems.METHODS: An integrative systematic review following PRISMA guidelines. A search strategy was applied to extract articles from included databases: CINAHL, MEDLINE, SCOPUS and Web of Science Core Collection. Articles were limited to English language and published January 2007-March 2022 and assessed using a pre-determined eligibility criteria. Quality assessment and a narrative synthesis were conducted.RESULTS: A total of 3321 articles were identified, and 27 studies included. There were (n = 10) qualitative, (n = 4) quantitative non-randomised controlled trials, (n = 3) quantitative descriptive studies and (n = 10) mixed methods. Nurse assessment and planning components were the most comprehensive phases incorporated into digital health systems, and interventions and outcome evaluation were scarcely reported.CONCLUSIONS: Inadequate capture of nursing work is a problem unresolved by digital health systems. This omission may be hindering nurse clinical decision-making for patient care and limiting the visibility of the nursing role in health care interventions and the associated impact on patient outcomes.RELEVANCE TO CLINICAL PRACTICE: Further research is needed on how digital systems can support nurses to apply the full nursing process and to further evaluate patient outcomes. Digital systems can support health-service level evaluation through capturing missed nursing care and the consequences on patients utilising nurse-sensitive-outcomes; however, this is not yet being realised.
KW - clinical decision making
KW - critical thinking
KW - information systems
KW - nursing assessment
KW - nursing information systems
KW - nursing intervention
KW - nursing process
KW - outcomes
KW - patient care management
KW - systematic reviews and meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85165478977&partnerID=8YFLogxK
U2 - 10.1111/jocn.16823
DO - 10.1111/jocn.16823
M3 - Article
C2 - 37485751
SN - 0962-1067
VL - 32
SP - 7010
EP - 7035
JO - Journal of Clinical Nursing
JF - Journal of Clinical Nursing
IS - 19-20
ER -